Be careful when using the popular nasal spray to treat rhinitis. The consequences are more serious than you think.

In the small circle of rhinitis patients, some Japanese Internet celebrity nasal sprays seem to have become the "life-saving straw" for many friends. One of my patient friends, Mr. Wang, is one of them. However, for him, this "life-saving straw" has become less and less useful recently.

Mr. Wang has had allergic rhinitis since he was a child. He usually has a stuffy nose and runny nose, which is even more serious when the seasons change. Maybe because Mr. Wang is a bit careless, he treats rhinitis only occasionally and never follows the doctor's advice completely. He has been muddling along for so many years. Later, he heard from a friend that a "net celebrity magic medicine" can treat rhinitis, so he tried it. Unexpectedly, the effect is amazing. It turns out that annoying symptoms such as nasal congestion, runny nose, sneezing, etc. can be cured by just spraying it. However, this miracle lasted for one or two years, and then it gradually stopped working.

Recently, he came to my clinic for help. According to him, his symptoms are now more severe than two or three years ago. He uses this nasal spray no less than ten times a day, but the duration of the effect is getting shorter and shorter. He wakes up at night and often feels sleepy and has headaches during the day. In the clinic, I took the nasal spray used by Mr. Wang and carefully analyzed and explained the ingredients in it to him, and judged that he might have drug-induced rhinitis.

So what are these so-called “Internet celebrity miracle drugs”? What are their main ingredients?

Take the Japanese popular nasal spray that is currently hot-selling on major e-commerce platforms as an example, such as a certain Fuji rhinitis spray, which has three main ingredients: naphazoline hydrochloride, chlorpheniramine maleate and benzalkonium chloride. Among them, naphazoline hydrochloride is a strong vasoconstrictor, also known as a decongestant, which can shrink the capillaries of the upper respiratory tract mucosa, reduce edema in the nasal cavity, shrink the inferior turbinate, and thus quickly relieve symptoms such as nasal congestion. Chlorpheniramine maleate, also commonly known as chlorpheniramine, is an old anti-allergic drug that can inhibit the release of histamine, reduce swelling of the nasal mucosa, and achieve the effect of relieving itching and stopping sneezing. Both ingredients are "powerful drugs" with rapid onset and strong effects. The combination of the two has a good effect on relieving the symptoms of allergic rhinitis in the short term. The third ingredient, benzalkonium chloride, has no therapeutic effect and only plays a preservative role.

There must be something wrong when something is abnormal. The effect is so good, is there no risk?

Since the Internet celebrity nasal spray is so effective, why are there so few ENT doctors who recommend it? First of all, although naphazoline hydrochloride can quickly relieve nasal congestion, long-term use can lead to rebound mucosal congestion and drug-induced rhinitis, making the symptoms of nasal congestion worse. The working principle of this type of decongestant is like squeezing the edematous nasal concha. It is very effective once or twice, but in the long run, the nasal concha is repeatedly "violently" contracted, just like an aging rubber, it loses its elasticity and can no longer be pinched. In addition, the blood vessels in the nasal cavity can contract, so can't other blood vessels in the body contract? For the same reason, it may also cause various side effects such as systemic vasoconstriction, increased blood pressure, and excitement of the heart. At the same time, another ingredient in the formula, chlorpheniramine, is a first-generation antihistamine that can enter the brain through the blood-brain barrier and may cause side effects such as drowsiness, sleepiness, and headaches.

In fact, if only these two ingredients are counted, this medicine is actually an old medicine. There are similar medicines in China, but none of them are the first choice medicines recommended by doctors for the treatment of allergic rhinitis. For example, when doctors prescribe nasal decongestants, they will warn that they cannot be used for a long time. They are generally only used for short-term relief of nasal congestion and other conditions, such as acute rhinitis. After relief, the medicine is stopped. It is rarely recommended to use it for more than one week. Similarly, if antihistamines are really needed, second- and third-generation antihistamines with fewer side effects are rarely used, and chlorpheniramine is rarely used. However, friends who are superstitious about online celebrity magic drugs generally buy drugs online by themselves, and know little about their side effects and hazards. Many buyers cannot understand the Japanese instructions and can only believe the seller's propaganda, so they use them for a long time without restraint.

Later, under my treatment and guidance, Mr. Wang gradually stopped using the "Internet celebrity magic medicine", and his rhinitis was slowly brought under control. In fact, from the perspective of professional guidelines, the "Guidelines for the Diagnosis and Treatment of Allergic Rhinitis" issued by the Chinese Medical Association's Otolaryngology and Head and Neck Surgery Branch clearly recommends nasal sprays and oral medications as first-line medications for allergic rhinitis, while naphazoline and chlorpheniramine are not recommended as long-term treatment drugs because of their poor long-term treatment efficacy and significant side effects.

In fact, the treatment of allergic rhinitis requires regular, scientific and orderly treatment. Any overnight effect may just be an illusion.